Coping with Chronic Pain (Follow-Up)

by Mara Karpel

Dear Dr. Karpel:

I actually printed out your recent column on pain.  Both of my parents suffer from chronic pain.  My dad recently developed severe idiopathic neuropathy (meaning “without a known cause”).  He is completely depressed as he always viewed himself as an able-bodied virile strong man.  However, he would deny his emotional symptoms, as depression is a sign of weakness in his eyes.  He says “our family is screwed up” and his “life is over.”  He won’t seek help outside of a neurologist (who placed him on a non-addictive pain medication – which does not help).  It’s especially tough because he is the caretaker of my mother.  I read him your column, which he acknowledged, but now he is back to his catastrophic thinking.  Any advice?


Dear Nicole:
It sure sounds like your dad is having a rough time.  As I mentioned in my
column about chronic pain, when pain is constant and there’s no known
cause, it can lead to a tremendous amount of both physical and emotional
stress.  The stress then can further increase the experience of physical pain
by causing fatigue, muscle tension, and sleep disturbance, all further contributors to pain.  When someone is experiencing severe pain without relief, life’s daily stressors can become magnified and appear to be insurmountable obstacles.  This then leads to depression, anxiety, social withdrawal, feelings of inadequacy, and feelings of being “beaten down” and abandoned and this is called the Pain Cycle.

This pain cycle sounds exactly like what your dad is experiencing.  On top of it, his daily stressors include something that would be highly stressful, even for someone with no physical pain.  That is, he is the caregiver for your mom.  All a perfect set up for becoming depressed…and from his statements you relate in your letter, he sounds like he’s already there.

Now, what can you do if your dad is denying that he’s depressed and refusing to seek help from someone who might be able to help?  This is a difficult question and there may be no magic answer.  He has the right to stay miserable, if he wants to.  However, I wouldn’t give up.  One avenue to take is to talk with him about how some anti-depressants, in a low dose, are often prescribed for the management of chronic pain.  In fact, there has been much research evidence showing that certain anti-depressant medications, such as those in the tri-cyclic class (amitriptyline, nortriptyline, desipramine) and certain novel antidepressants (i.e., bupropion, venlafaxine, duloxetine), have been found to be quite effective at reducing pain when analgesics have not helped.  These medications may have the added benefit of beginning to treating the depression, as well.  Once his mood starts to improve, with the medication, he may agree to further treatment of his depressive symptoms.  Perhaps, once out of a hopeless state, he might be more agreeable to psychological counseling to learn better ways of coping with the pain and the stressors in his life, as well.

Since your dad trusts his neurologist, you might try elicit the help of this doctor.  Ask your dad if it’s ok for you to speak with his neurologist and, if he says yes, you can tell his doctor what you’re seeing.  His doctor can then be the one to suggest anti-depressant medication for the pain, to let your dad know that he may be depressed and that this is further contributing to his pain, and to encourage your dad to receive treatment for the depressive symptoms in order to improve the quality of his life, even if he continues to have some pain.

Nicole, if your dad is resistant with these approaches, I wouldn’t give up.  You may need to repeat yourself several times.  Point out the pain cycle to him.  Let him know that you feel he is depressed and needs help.  And keep encouraging him to receive treatment.  Eventually, he may hear you and agree to take some steps toward feeling better.  Good luck and please let me know how this turns out.

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